Cochlear implants (CIs) and Bone anchored hearing devices (BAHAs)

a device made of both internal and external components: the external component is worn outside the head and the internal device is surgically implanted into the cochlea and along the skull

cochlear implant

CIs produce a programmed __________ that bypasses damaged structures within

the ________ear and stimulates healthy auditory nerve endings

electrical current, inner

CIs were developed for what type of HL

sensorineural

CIs were developed for sensorineural HL and provides direct stimulation to the __________________

auditory nerve

Considered the most successful sensory prosthetic in medical history

CI

t/f CIs do NOT restore normal hearing

true

The brain must learn to interpret signals from the CI -- the wearer is now receiving

electrical impulses to their ________ instead of hearing the traditional way.

auditory nerve

difference between hearing aid and cochlear implant

HA amplifies sound and CI converts sound into electrical impulses

for HA, it requires a ______________ because ________ must send info about the sound to the brain, but a CI doesn't require a working cochlea because it bypasses ______ hair cells

working cochlea, hair cells, damaged

which requires surgery, a HA or CI

CI

difference between adjustment period between HA and CI

HA require a shorter adjustment period and CI takes longer adjustment period

why does CI take a longer adjustment period

bc the brain must "re-

learn" how to hear using pulses as the input

signal

difference between the parts of a HA and a CI

for HA, all parts are external (worn behind or in the ear) and for CI, it consists of both external and internal (implanted) parts

how much AR is needed for children/adults with HA compared to children/adults for CI

A lot of AR is need for children with HA and not as much for adults; a lot of AR is require for children and adults with CI

list the 3 CI manufacturers

cochlear, MED-EL, advanced bionics

list the external parts of a CI:

(4)

microphone, speech processor, transmitter coil, external magnet

list the internal components of a CI:

(3)

receiver/stimulator, internal magnet, electrode array (inserted into cochlea)

how CI works:

_____->_____->_____->_______->________->_______

1. sound

2. coded signal

3. transmitted to implant

4. electrical stimulation

how cochlear implants work- the steps:

1. microphone picks up sound and turns it into a signal

2. speech processor analyzes and codes the sound

3. signal is sent to the external coil, then transmitted across the skin to the internal device

4. internal implant converts the signal into electrical impulses

5. these impulses are sent to the electrodes in the cochlea

6. electrodes stimulate the auditory nerve which sends the signal to the brain

list the steps for a CI process:

(7)

1. audiologist refers patient for CI evaluation

2. audiological CI evaluation

3. medical clearance and imaging

4. surgery

5. activation one month after surgery

6. continued follow-up appts with audiology for programming

7. aural rehab

what does a audiological CI evaluation consist of

counseling on CI basics, a hearing test, and aided speech testing

when should you consider a CI evaluation in adults

when they have An unaided word recognition score of ≤60%

and an unaided pure-tone average

≥60 dB HL in the best ear.

when to consider CI eval in infants and toddlers:

(5)

1. does not react to loud sounds

2. does not seek out or detect where sound is coming from

3. has stopped babbling and experimenting with making sounds

4. still babbles but is not progressing to more understandable speech

5. no reaction to voices, especially when being held

when to consider CI eval in school age children:

(5)

1. repeatedly misses/doesn't respond to all LING sounds with appropriately fit hearing technology

2. increased dependency or remote microphone technology or visual cues

3. demonstrates slow auditory progress

4. easily frustrated or experiences communication breakdowns

5. exhausted at end of school day due to constant concentration trying to understand speech

CI candidacy criteria for adults:

(4)

1. bilateral moderate to profound sensorineural HL

2. limited benefit from appropriately fit HA

3. normal anatomy suitable for implantation

4. good candidates are motivated and have realistic expectations

CI candidacy criteria for children 9-24 months of age:

have bilateral

profound sensorineural hearing loss

CI candidacy criteria for children two years of age or older:

have severe to profound hearing loss bilaterally who

demonstrate limited benefit from hearing aids

CI candidacy criteria for young children:

lack of progress in the

development of simple auditory skills when appropriately aided

CI candidacy criteria for older children:

≤30% correct on open set word

recognition tests

CI candidacy criteria for all children:

Normal anatomy suitable for implantation

cochlear implant surgery is performed by an ______/______ surgeon

otologic/ENT

cochlear implant surgery:

(5)

1. incision made behind ear

2. internal receiver placed under skin

3. electrode array inserted into cochlea

4. patient goes home same or next day

5. device activated about a month later

what does BAHA stand for

bone anchored hearing aid

A bone conduction hearing device that bypasses the outer and middle ear

BAHA

a BAHA sends sound vibrations directly to the _________ via the ___________

cochlea, skull

BAHAs are meant for patient with what kind of HL?

conductive or mixed

BAHAs are also a solution for __________

single-sided deafness

There are different types of BAHAs based on how they are _________ and _________

implanted, transmit sound

list the 4 types of BAHAs

1. active transcutaneous

2. passive transcutaneous

3. passive non-magnetic

4. percutaneous

3 BAHA manufacturers:

1. cochlear

2. MED-EL

3. Oticon Medical

Consist of an implanted transducer that is completely under the skin and a sound processor

outside of the skin

transcutaneous BAHA

one part of the transducer is implanted, and the other part is kept outside the skin and outside of the intact skin and soft tissue

transcutaneous BAHA

transcutaneous BAHAs use a _________ to attach the sound processor to the implant

magnetic connection

two types of transcutaneous BAHA

active and passive

which transcutaneous BAHA: the external part picks up sound signals and sends them through the skin to the internal implant, which generates vibrations to be sent to the inner ear

active

which transcutaneous BAHA: the external sound processor generates vibrations (the sound processor itself vibrates) and sends these vibrations through the skin to the implant

passive

Implant connects directly through the skin via an

abutment.; Sound processor attaches to the abutment and sends vibrations directly to the skull; These vibrations travel to

the inner ear where they are processed and then sent to the brain to be interpreted as sound.

percutaneous BAHA

____________ Yields the best sound transmission since it has a direct drive to the bone (skull)

percutaneous BAHA

percutaneous BAHA Runs the risk of failure to ______________(the abutment

does not settle into the skull properly and has to be

removed).

osseointegrate

External processor held in place by a headband,

softband, or adhesive (no surgery required); Processor presses against skull and sends

vibrations through the skin to the skull.

passive non-magnetic BAHA

which BAHA is Used for infants/young children or to trial before surgery

passive non-magnetic BAHA

is a passive non-magnetic BAHA more or less stable placement than implanted options

less

passive non-magnetic BAHA has a Weaker signal due to _____________

soft tissue attenuation

what does soft tissue attenuation mean

vibrations have to travel through skin